Basic Information
| Provider Information | |||||||||
| NPI: | 1023004991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5315 DELHI AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452385214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139222335 | ||||||||
| FaxNumber: | 5139224454 | ||||||||
| Practice Location | |||||||||
| Address1: | 5315 DELHI AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452385214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139222335 | ||||||||
| FaxNumber: | 5139224454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 1707 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000000012371 | 01 | OH | BLUE CROSS/BLUE SHIELD | OTHER | 0318043 | 05 | OH | MEDICAID | 27-00262 | 01 | OH | EVERCARE,UNITEDHELATHCARE | OTHER | 311164051 00 | 01 | OH | WORKERS COMPENSATION | OTHER | 1287600001 | 01 | OH | MEDICARE DURABLE ID NUMBE | OTHER | 27000546 | 01 | OH | UNITED HEALTHCARE | OTHER | 648840 | 01 | OH | AETNA | OTHER |